Provider Demographics
NPI:1699799916
Name:OFFICER, LAURA J (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:OFFICER
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N WASHINGTON AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-5984
Mailing Address - Country:US
Mailing Address - Phone:931-526-1604
Mailing Address - Fax:931-526-7378
Practice Address - Street 1:315 N WASHINGTON AVE STE 190
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-5984
Practice Address - Country:US
Practice Address - Phone:931-526-1604
Practice Address - Fax:931-526-7378
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000096823363LF0000X
TN6838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3648425Medicare ID - Type Unspecified